Kamolnik,Colleen_2022-2nd-qtrAmendment
Disclosure Report Cover ❑ Yes * No
Use this form for general report and committee information, must be signed and submitted along with other detailed forms.
Do not use this Corm to UPaale tmormauoa.
1. Committee Information
e. Foil Name-
c. ID Number
11foA Um In DE Distil I
. Maniag Address (include City, State and Zip Code)
d. hate Filed
'721 01IC l -✓1
/Y2
0-110-7120
e. Phone Number
ID 4 29 10 4S1o+
kA04 roC MC' ZT"7-
Report Year 3. Period Start Date (mm(aaryy> 4. Period End Date (nm(aa yy)LitTreasurer FullName20220510112ozz
O10I$p 201 al
6. Type of Committee (Check One) 9. Type of Report (check only one type of reportfrom one category)
Candidate Campaign ❑ Party Municipal Stute/Comty Referendum
PAC ❑ Referendum ❑ Organizational ❑'( gaairadonal ❑ Organizational
❑ independent Expenditure ❑ Joint Fundraiser ❑ 7hinY-five day Quarterly ❑ Pre -referendum
❑ Legal Expense Fund ❑Pre-primary ❑ First ❑ Final
❑ Predation Second ❑ Supplemental Final
7. Type of Fund- applicable, check one).. ❑Pre-maoff L3 Third Annual
— ❑ Special
[3d Booster Fun Semi-annual ❑Fourth
❑ Building Fund L3 Mid Year Semi-annual
[3Year End ❑ Mid Year 10. Special Report Name_
❑ Other. ❑ Final ❑ Year End
8. Number of Fundraisers this Report ❑ Special ❑ Final
/ems ❑ Special
11. Account Information 11. Account Information
. Financial Institution Full Name a. Financial Institution Full Name
AMM(AV1 Ban k-
. Purpose c. Account Code b. Purpose Code
JUL 0 7 2
yt
(,q m 19 n f W11d1 j d. Period Begin Balanceit. Period Begin Balance
pa
$ 20V. q0 Union Co. Ele tlbns
CERTIFICATION
I certify that the Committee or Fund is in compliance with plicable rovisions of Article er Chapter 161
clos22Ad fu d . Ifurt certify is
of the NC General Statutes and that no funds are commie ed �th prohibi d or other non -disclosed foods. I further certify that this
report is complete, true and correct and that I have been C S to of tions.
C 1UAn m &Af M81611 0�10-llzotz
Printed Name of Si er Signature of Appointed Treasurer Date
OR OFFICE USE ONLY
Delivery Method
Date Received: o"a" Employee: ❑ Normal Mail
❑ Registered Mail
Date Postmarked: Employe jjB� Hand Delivered
Electronically Filed
Date Scanned: Employee:
1-3Signer has not received
Employee:
Date Data Entered:mandatory tramtn
Please Note: This form cannot be used to amend committee information such as the committee address, treasurer,
assistant treasurer, custodian of books information, or account information.
You must amend the Statement of Organization (CRO -2100A -E) to make committee changes.
August 2008
CRO -1000
Amendment
Detaffed Summary ❑ Yes A N„
__ ..r..rot _n t.r infnr,nafinn
Use tms tumt
1. Com_miuee Nme�(_if apP cable_
Co ken K.Am01ni k for MD6tm+1
— -
2. o Report
zcaz Setond Qua
_Number
Start of Election Cycle: January 1, 201 q_
Total this
Reporting Period
Total this
Election Cvcle
4) Cash on Hand at Start
$ 206 AO
$
RECEIPTS
5) Aggregated Contributions from Individuals (CRO -1205)
6) Contributions from Individuals (CRO -1210)
7) Contributions from Political Party Committees (CRO -1220)
8) Contributions from Other Political Committees (CRO -1230)
9) Loan Proceeds (CRO -1410)
10) Refunds/Reimbursements to the Committee (CRO -12,40)
11) Other Receipt Sources
Ila) Interest on Bank Accounts (CRO -1250)
llb) Contributions from Not -For -Profit Organizations (CRO-12So)
Iic) Outside Sources of Income (CRO -1250)
l Id) Legal Expense Fund -Other Sources (CRO -1270)
Ile) Exempt Purchase Price Sales (CRO -1265)
$
$
$
$ 1 q Z . 00
$ S(0 7 ..S $
$ 3 (s1 . S $
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
12) TOTAL RECEIPTS (Add fines 5,6,7,8,9,10,1la,llb,l]c,lldandlle)
$ 'i.rj$
$ 22chp.so,
EXPENDITURES
13) Disbursements
13a) Operating Expenditures (CRO -1310)
13b) Contributions to Candidates/Political Committees (CRO -1310)
13c) Coordinated Party Expenditures (CRO.1310)
14) Aggregated Non -Media Expenditures (CRO -1315)
15) Loan Repayments (CRO -1420)
16) Refunds/Reimbursements from the Committee (CRO -1320)
17) In -Rind Contributions (CRO -1510)
$ ¢
$ 4.2.1. 7
$
$
$
$
$ .3$ , 00
$ 40-3-1-9
$
$
$
$
$
$ 29.Qa
18) TOTAL EXPENDITURES (Add lines 13a, 13b, 13c, 14, 15, 16 and 17)
$
$
19) Cash on Hand at End (Add lines 4 and 12 together, then subtract line 18
$
1436 • LIPS
)MMONAL IIVFORMATION
0) Non -Monetary Gifts Given to Other Committees (CRO -1330)
1) Outstanding Loans (incl. ones from other campaigns) (CRO -1430)
2) Debts and Obligations owed by the Committee (CRO-i61o)
3) Debts and Obligations owed to the Committee (CRO -1620)
24) Account Transfers Within the Committee (CRO -1720)
5) Administrative Support QIMK
) Forgiven Loans a,f(C�AR7O�1.1440)
48 -Hour Notice Reports Sum JUL_ �'A
E7)
Contributions to be Refunded
,,,..
$
$
$
$
$
$
$
$
$
$
Aueust 2008
CRO -1100
Amendment
Contributions from Political Party Committees Pg nr ❑ Nes k,,.
Use this form to report contributions from a political party
1. Committee Fall_Name (and Fund if app _
Co I I P Fn 4i ry10 /„i „t- � f BOE” P1,514;Y4 /,
2. ID Number
3. Contributor Information Add ❑ Remove
. Full Name, Mailing Address & Phone
(Include city, state, & zip)
.ksslut Cook for LACES Boowd of GOLUC&#t.wt
lobi FIvf Craf Lrl
Waw h a W t WC. 2-81-13
b. Comments
c. Election Sum to Date
$ 36-1. s s
d.AccowatCode
e. Form of Payment
t. In -Kind Description
g. Date (mmld;-V )
b4,1231202Z
h. Amount
chew
$3�-►.ss
$
$
. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
h. Comments
c. Election Sum to Date
$
. Account Code
e. Form of Payment
f. In -Kind Description
S. Date (mmidd/yyyy)
h. Amount
3. Contributor Information ❑ Add ❑ Remove
. Full Name, Mailing Address & Phone
(include city, state, & zip)
JUL 0 7 2022 i$
b. Comments
c. Election Sum to Date
d. Account Code
e. Form of Payment
I. Iu.Ktod Description
Date (mmlddlyyyy)
h. Amount
Union Co. Election
$
$
$
4. Total only this Page
$ 3 b-7. s 8
5. Total of ALL CRO -1220 Pages
(This Gse s art be online 7 oJDetailed Summary Page CR0.1100)
$
CRO -1220 NC State Board of Elections April 2W7
Amendment
Aggregated Non -Media Expenditures Page or I ❑ Yes Cq No
Optional form used to report NC Non -Media Expenditures of $50 or less.
1. Conunittee Full Name an app aNumber
CojWkj aMOWL iD( B06 D1 I
Informationd
b. Account Code c.
Form or Payment
d. Purpose Code e.
Date (rnnJddlyyyy)
f. Amountove
draft
o
1ove
I
ove
Ve
CQcvzd
$ 29-oo
websovedp
Z05101.)ZoL-L
o6�oZj2oz.Z
$2ove
�
{ idmoved
$
❑ Remove
Add
$
❑ Remove
odd
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
$
❑ Remove
Add
❑ Remove
Add
JUL
$
❑ Remove
Add
❑ Remove
on co. Election
$
Add
$
❑ Remove
4. Total
only this Page
$
- CY0
5. Total of ALL CRO -1315 Pages
$ 3% , 00
(This hne must be on fine 14 of Detailed SwnmmIy Pare CRO -1100)
V
B* - Printing C* - Fundraising D - To Another Candidate
E - Salaries F* - Equipment G - Political Party H* - Holding Public OfficeExpenses
I - Postage J - Penalties K* - Office Expenses Q* - Donations to Legal Expense Fund
O* - Other
* O -A .e ,,:. o dwta:lpet nxn{anation in required remarks field (2)
R -131 S NC State Board of Elections f° 21109